外伤性脾破裂诊治剖析.docVIP

外伤性脾破裂诊治剖析 　　【摘要】目的：总结外伤性脾破裂的诊治经验，以提高脾破裂的诊治水平。方法：回顾性分析我院自1998年1月～2005年12月收治的68例外伤性脾破裂的诊断和治疗。结果：根据外伤史、体查、诊断性腹穿和B超、CT等检查，诊断正确率为94.12%。非手术治疗11例(16.17%)，均保守治疗成功；手术治疗57例，除3例术中死亡外，均一期手术成功，痊愈出院。结论：外伤病史的详细询问和体查，多部位反复的腹腔穿刺和必要的辅助检查是提高脾破裂诊断率的关键。外伤性脾破裂在确保患者生命安全的前提下，应尽可能保留脾脏，尤其是儿童。 　　【关键词】脾破裂；外伤；诊断 　　文章编号：1009-5519（2007）12-1750-02 中图分类号：R6 文献标识码：A 　　Diagnosis and treatment of traumatic splenic rupture 　　HUANG Yong-lang1，WU Wei-ji2 　　(1.Songbai Commune Hospital of Yangchun，Guangdong 529614，China；2.The Peoples Hospital of Yangchun，Guangdong 529600，China) 　　【Abstract】Objective：To summarize our experiences in the diagnosis and treatment of traumatic splenic rupture (TSR)，in order to improve the diagnosis and treatment level of TSR. Methods：Retrospective analysis of the diagnosis and treatment in 68 patients with traumatic splenic rupture in recent 8 years was made. Results：The preoperative correct diagnosis rate was 94.12% and was established on the history of injury， clinical presentation， abdominal paracentesis，abdominal uhrasonography and CT. All the 11 patients treated nonoperatively were cured. Of the 57 patients treated by operation，3 died during operation and 54 patients were cured.Conclusion：Combination of obtaining a detailed history of injury， physical examination，abdominal paracentesis， abdominal ultrasonography and CT can improve the accuracy rate of preoperative diagnosis. Under the ensurance of the safety of the patients life，preservation of the spleen should be performed if possible，especially for children.Both splenorrhaphy with or without ligation of splenic artery are simple，safe and effective methods to salvage the spleen. 　　【Key words】Splenic rupture；Trauma；Diagnosis 　　 　　我院自1998年1月～2005年12月共收治外伤性脾破裂68例，现报道如下。 　　 　　1 资料与方法 　　 　　1．1 一般资料：本组68例中男43例，女25例，年龄3.5～67岁，平均31.6岁。脾外伤分级按美国创伤外科协会(AAST)分级标准。Ⅰ级(包膜下血肿50%，包膜下血肿破裂或实质内血肿破裂，实质内血肿5 cm或扩展性，撕裂3cm或累及小梁血管)20例(29.41%)，Ⅳ级(25%的脾脏丧失血供)13例(19.12%)，Ⅴ级(完全破裂或脾蒂严重受损失)12例(17.65%)。腹腔内积血≥1 000 ml者44例(64.71%)，术前伴有休克症状